High prevalence of comorbidities in older adult patients with type 2 diabetes: a cross-sectional survey.

BACKGROUND: Diabetes is a global health problem, and its incidence and complications increase with the duration of the disease and over time. This increase in complications in older patients can lead to disability and a lower quality of life. This study aimed to investigate the rate of diabetes control and complications in older adults. METHOD: This was a cross-section of an ongoing cohort of patients with type 2 diabetes mellitus (T2DM) aged 65 years and older. The clinical and laboratory characteristics of older adult patients with T2DM in good and intermediate health conditions were collected between 2010 and 2022. RESULTS: A total of 2,770 older adult patients with T2DM were enrolled, including 1,530(55.3%) female and 1,240 (44.7%) male participants. Metabolic syndrome, hypertension, and coronary artery disease were the most common comorbidities, affecting 1,889 (71.4%), 1,495 (54.4%), and 786 (29.2%) patients, respectively. Albuminuria was present in 626 (22.6%) patients, while retinopathy was detected in 408 (14.7%) patients, including 6% with proliferative retinopathy. Most patients were treated with oral antidiabetic agents (88.9%), with metformin being the most prescribed medication (85.6%). Statins were prescribed to 71.8% of the patients. The most prescribed antihypertensive medications were angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, prescribed to 54% and 15% of patients, respectively. The hemoglobin A1c (HbA1c) goal (HbA1c < 7.5%) was achieved in 1,350 (56.4%) patients, and the low-density lipoprotein cholesterol (LDL-C) goal (LDL < 100) was achieved in 1,165 (45.6%) patients. Blood pressure control (BP < 140/90) was achieved in 1,755 (65.4%) patients. All three goals were achieved in 278 (10.3%) patients. There were no significant differences in clinical laboratory results and the patients' characteristics based on gender. CONCLUSION: The rate of progression of complications in older adult patients is higher than the effectiveness of the treatment, indicating the need for increased social support for this age group.

Clinical Application of Artificial Intelligence in Prediction of Intraoperative Cerebrospinal Fluid Leakage in Pituitary Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND: Postoperative cerebrospinal fluid (CSF) leakage is the leading adverse event in transsphenoidal surgery. Intraoperative CSF (ioCSF) leakage is one of the most important predictive factors for postoperative CSF leakage. This systematic review and meta-analysis aimed to evaluate the effectiveness of artificial intelligence (AI) models in predicting ioCSF. METHODS: Literature records were retrieved on June 13, 2024, using the relevant key terms without filters in PubMed, Embase, Scopus, and Web of Science. Records were screened according to the eligibility criteria, and the data from the included studies were extracted. The quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The meta-analysis, sensitivity analysis, and meta-regression were conducted using R software. RESULTS: Our results demonstrate that the AI models achieved a pooled sensitivity of 93.4% (95% confidence interval [CI]: 74.8%-98.6%) and specificity of 91.7% (95% CI: 75%-97.6%). The subgroup analysis revealed that the pooled sensitivities in machine learning and deep learning were 86.2% (95% CI: 83%-88.8%) and 99% (95% CI: 93%-99%), respectively (P < 0.01). The subgroup analysis demonstrated a pooled specificity of 92.1% (95% CI: 63.1%-98.7%) for machine learning and 90.6% (95% CI: 78.2%-96.3%) for deep learning models (P = 0.87). The diagnostic odds ratio meta-analysis revealed an odds ratio 114.6 (95% CI: 17.6-750.9). The summary receiver operating characteristic curve demonstrated that the overall area under the curve of the studies was 0.955, which is a considerable performance. CONCLUSIONS: AI models have demonstrated promising performance for predicting the ioCSF leakage in pituitary surgery and can optimize the treatment strategy.

May position of hemodialysis catheter tip have a direct effect on its patency? Positive results of a preliminary study on its rotation.

Renal transplant therapy is essential in patients with End-Stage Renal Disease (ESRD). It is used in patients awaiting a kidney transplant or those who cannot be a transplant candidate. Central venous catheter is one of the most used access routes worldwide but has been recorded as the one with highest mortality and morbidity rate. Thromboembolic events have played a major part for that. This is a descriptive-analytical study, which conducted in a university treatment center in Tehran, Iran. A total of 225 patients were selected for this study that 108 were excluded because of our criteria. Statistical analysis was performed by SPSS v19 and a total of 117 patients were included in this study. The average age of the patients was 51.62±11.26. 79 (67.5%) and 38 (32.5%) patients had medial and lateral tip direction, respectively. The catheter of 85(72.6%) and 32(27.4%) patients was patent and occluded, respectively. The average catheter tip occlusion time in both groups was 22.5 and 7.5 months. Three-month, six-month, twelve-month, and twenty-four-month patency rate were 99%, 94%, 88%, and 30%, respectively. our findings suggest that medial direction of the tip of the catheter reduces complications caused in CVS. Because our study has been conducted in a small scale and there is lack of similar studies, our team suggests extension to a larger scale to confirm or not our results.